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GI- Inflammatory Bowel Disease
Terms in this set (35)
What kind of condition is ulcerative colitis and Crohn's Disease: Inflammatory bowel disease or irritable bowel syndrome?
Inflammatory Bowel Disease
Chronic inflammation of all or part of the colon
Describe what parts of the digestive tract affected by ulcerative colitis?
Involves the rectum and may extend proximally in a continuous fashion to part or all of the colon
Describe what parts of the digestive tract are affected by crohn's disease
Chronic, recurrent, patchy transmural inflammation in any portion of the GI tract from mouth to anus, but affects mostly the ileum. 2nd most common is the colon only and 3rd is small bowel only
Describe the difference between ulcerative colitis and crohn's disease
Ulcerative Colitis: Inflammation of the mucosal layer of the colon only
Continuous pattern of inflammation
Mostly acute or subacute
Crohn's Disease: Transmural inflammation, often leads to perforation, three types (inflammatory, stricturing, perforating), has a skip-lesion pattern
Whats the difference on H+P findings on ulcerative colitis and crohn's disease
Ulcerative colitis: Bloody Diarrhea
Crohn's Disease: Non-bloody diarrhea
What are the laboratory findings associated with IBD
Anemia +/- Fe deficiency
Increased ESR and CRP (For Crohn's)
What imaging is done to diagnose IBD?
On KUB imaging: wall thickening of transverse colon with thumbprinting
Can't base diagnosis solely on one test. Based on combination of patient history, PE, Lab, radiographic, endoscopic and histological findings
Biopsy of colon shows acute inflammation
Key: rule out infectious pathogens
What is the primary goal of IBD treatment?
Symptom relief (acheive remission and maintain remission)
What is the secondary goal of IBD management?
What drug is used to treat Ulcerative colitis
What drug is used to treat Crohn's Disease
Anti-TNF Agents (infliximab), Surgery
Also can treat with 5-Aminosalicylates
What are the complications associated with IBD
Iron, Folate, B12, Vitamin A, D, E and K deficiency
Bile salt diarrhea
Short gut syndrome
Toxig megacolon with infarction
Describe Toxic Megacolon
Gross dilation of transverse colon which measures approximately 10cm in maximum diameter, evidence of pseudopolyp formation
This is a surgical emergency
What are the risk factors for cancer associated with IBD?
Duration and extent for disease
Severity of Inflammation
Family history of colorectal cancer
Concominant primary sclerosing cholangitis
Early age of onset
Premalignnt dysplastic epithelium
What are the cancer screening recommendations for IBD?
Colonoscopy after 8 years of diagnosis, then every 1-2 years after initial scope
Random 4 quadrant biopsies every 10cm throughout the colon
Colectomy for any low-grade dysplasia
What are associated conditions associated with IBD
polyarticular peripheral arthritis
Describe the external manifestations of Hepatobiliary issues associated with IBD
Describe the external manifestations of Dermatologic issues associated with IBD
Describe the external manifestations of oral issues associated with IBD
Describe the external manifestations of Ocular issues associated with IBD
Describe the external manifestations of Musculoskeletal issues associated with IBD
Describe the external manifestations of hematologic issues associated with IBD
What is the epidemiology of IBS?
Women 20-40 years old
10-20% of adult population
21 billion annual cost to USA
What is the diagnostic criteria to diagnose IBS?
Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months associated with 2 or more of the following:
Improvement with defecation
Onset associated with a change in frequency of stool
Onset associated with a change inform appearance of stool
Describe the pathophysiology of IBS
Motility: Exaggerated motility response to meal ingestion
Visceral Hypersensitivity: increased pain sensitivity to gut stimulation
Post infective IBS: 11% post gastroenteritis pts develop within 2 years
Stress response/psychiatric/post abuse: altered stress circuits
How long does a person have to have symptoms before you can diagnose them with IBS?
Describe the bristol stool scale
Scale of 1-7, 1 is very hard stool and 7 is most loose stool
What are non-GI symptoms associated with IBS
Nocturia, frequency, and urgency
Incomplete bladder emptying
Stress aggrevates symptoms
What are the psychological features associated with IBS
Depressive or anxiety disorder
What are the physical exam findings associated with IBS?
None, but have to rule out other diseases
What are the laboratory and imaging studies done to diagnose IBS?
Serologies for Celiac Disease
Stool for Fecal Occult Blood
Colonoscopy in patients >50, with positive FOBT, rectal bleeding or family history of colon cancer
What drugs are used to treat IBS-related diarrhea
What drugs are used to treat IBS-related constipation?
What drugs are used to treat IBS-Related abdominal pain
Smooth muscle relaxant
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